Child wasting—that is, low weight for height, reflecting acute undernutrition—is the most dangerous form of malnutrition. Affecting 13.7 million children a year worldwide, wasting is responsible for up to 20 percent of deaths of children under the age of five (Osendarp et al. 2025).

Fortunately, much has been learned about the best ways to treat wasting. The widespread rollout of community management of acute malnutrition (CMAM), an approach pioneered by Concern and Valid International in 2001, has revolutionized care by enabling early detection and decentralized treatment using ready-to-use therapeutic foods (WHO et al. 2007). Progress on preventing wasting, however, remains a complex challenge. Stopping child wasting before it can start demands interventions across multiple sectors—including improved maternal health, optimal infant and young child feeding, access to clean water, sanitation, and responsive health systems—yet such integrated approaches are still not systematically implemented or adequately funded at scale.

In 2023, Concern Worldwide and several partners launched the Hanaano program (hanaano means “to nurture” in Somali) to tackle the complex problem of child wasting in the Mandera Triangle, an arid and semiarid region that crosses the borders of Ethiopia, Kenya, and Somalia. The Mandera Triangle is populated mostly by mobile pastoralists, refugees, seasonal cross-border laborers, undocumented migrants, internally displaced persons (IDPs), and communities hosting refugees and IDPs (Interpeace 2021). It is one of the most challenging contexts in which to sustain livelihoods and has some of the highest levels of food insecurity and malnutrition in the Horn of Africa. At the peak of the 2020–2023 drought, the prevalence of global acute malnutrition, reflecting child malnutrition, in the Mandera Triangle reached 35 percent— more than double the 15 percent emergency threshold established by the World Health Organization (IPC 2022).

Given the complexity of preventing child wasting, the Hanaano program supports communities in the Mandera Triangle in building local capacity across a range of sectors, including health; agriculture; food security; water, sanitation, and hygiene; social protection; and environmental management. Through efforts in these areas, the program aims to improve nutrition and care practices for women and children and to enhance food security through profitable, climate-resilient livelihood strategies, while contributing to the evidence base that informs national and regional strategies.

In the first year of Hanaano, preliminary assessments indicate that 1,600 women attended mother-to-mother groups, 800 lead farmers received seeds and agricultural tools, 7,000 people gained access to clean and safe drinking water, 11,500 farmers gained access to livestock veterinary services and drugs, and more than 251,000 were reached through behavior change campaigns.

Shinda (age 33), mother of six, reports that she attended Hanaano cooking demonstrations to complement agricultural training. From these classes, she explains, she now has a better understanding of how to prepare nutritious meals using produce she grows at home. Since the change in their diet, Shinda says her children are “now strong, healthy, and full of energy.”

The aim of Hanaano is to prevent wasting among more than 305,000 children living in the most vulnerable communities in the Mandera Triangle over a span of three years. It is also hoped that through active learning, contextual program adaptation, and locally led advocacy, Hanaano will influence and inform more effective local, national, and global wasting prevention strategies.

1. This case study was prepared by Concern Worldwide. The Hanaano program is supported by Irish Aid, as part of Ireland's support to ending child wasting, a commitment under the Global Action Plan on Child Wasting. It is a joint effort by the Intergovernmental Authority on Development (IGAD), Concern Worldwide, local partners (Rural Agency for Community Development and Assistance [RACIDA] in Kenya, Pastoralist Concern in Ethiopia, and Lifeline Gedo in Somalia), and Tufts University. Hanaano aims to contribute to this evidence space while also supporting communities to develop local capacity to prevent and address wasting.